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Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study

  • Laryngology
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The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes.


We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I–IV according to Myer–Cotton grading system), number of subsites involved (“a” to “d” for 1–4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity (“+” sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments.


The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001).


The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.

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  1. Choo KK, Tan HK, Balakrishnan A (2010) Subglottic stenosis in infants and children. Singapore Med J 51:848–852

    PubMed  CAS  Google Scholar 

  2. Lesperance MM, Zalzal GH (1998) Laryngotracheal stenosis in children. Eur Arch Otorhinolaryngol 255:12–17

    Article  PubMed  CAS  Google Scholar 

  3. Cotton RT (1984) Pediatric laryngotracheal stenosis. J Pediatr Surg 19:699–704

    Article  PubMed  CAS  Google Scholar 

  4. Ikonomidis C, George M, Jaquet Y et al (2010) Partial crocotracheal resection in children weighing less than 10 kilograms. Otolaryngol Head Neck Surg 142:41–47

    Article  PubMed  Google Scholar 

  5. George M, Jaquet Y, Ikonomidis C et al (2010) Management of severe pediatric subglottic stenosis with glottic involvement. J Thorac Cardivasc Surg 139:411–417

    Article  Google Scholar 

  6. Yamamoto K, Jaquet Y, Ikonomidis C et al (2015) Partial cricotracheal resection for paediatric subglottic stenosis: update of the Lausanne experience with 129 cases. Eur J Cardiothorac Surg 47:876–882

    Article  PubMed  Google Scholar 

  7. Goh BS, Roopesh S, Marina MB, Abdullah SM (2014) Partial cricotracheal resection (PCTR), a rewarding outcome for pediatric subglottic stenosis: an early experience. Med J Malays 69:13–15

    CAS  Google Scholar 

  8. Gustafson LM, Hartley BE, Cotton RT (2001) Acquired total (grade 4) subglottic stenosis in children. Ann Otol Rhinol Laryngol 110:16–19

    Article  PubMed  CAS  Google Scholar 

  9. George M, Ikonomidis C, Jaquet Y et al (2009) Partial cricotracheal resection for congenital subglottic stenosis in children: the effect of concomitant anomalies. Int J Pediatr Otorhinolaryngol 73:981–985

    Article  PubMed  Google Scholar 

  10. Torre M, Carlucci M, Avanzini S et al (2011) Gaslini’s tracheal team: preliminary experience after one year of paediatric airway reconstructive surgery. Ital J Pediatr 37:51

    Article  PubMed  PubMed Central  Google Scholar 

  11. Myer CM 3rd, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103:319–323

    Article  PubMed  Google Scholar 

  12. Lano CF Jr, Duncavage JA, Reinisch L et al (1998) Laryngotracheal reconstruction in the adult: a 10 year experience. Ann Otol Rhinol Laryngol 107:92–97

    Article  PubMed  Google Scholar 

  13. Miller R, Murgu S (2014) Evaluation and classifications of laryngotracheal stenosis. Revista Americana de Medicina Respiratoria 4:344–357

    Google Scholar 

  14. Freitag L, Ernst A, Unger M et al (2007) A proposed classification system of central airway stenosis. Eur Respir J 30:7–12

    Article  PubMed  CAS  Google Scholar 

  15. Nouraei SA, Nouraei SM, Upile T et al (2007) A proposed system for documenting the functional outcome of adult laryngotracheal stenosis. Clin Otolaryngol 32:407–409

    Article  PubMed  CAS  Google Scholar 

  16. Monnier P, Ikonomidis C, Jaquet Y, George M (2009) Proposal of a new classification for optimising outcome assessment following partial cricotracheal resections in severe pediatric subglottic stenosis. Int J Pediatr Otorhinolaryngol 73:1217–1221

    Article  PubMed  Google Scholar 

  17. Monnier P, Dikkers FG, Eckel H et al (2015) Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society. Eur Arch Otorhinolaryngol 272:2885–2896

    Article  PubMed  Google Scholar 

  18. Piazza C, Del Bon F, Paderno A et al (2014) Complications after tracheal and cricotracheal resection and anastomosis for inflammatory and neoplastic stenoses. Ann Otol Rhinol Laryngol 123:798–804

    Article  PubMed  Google Scholar 

  19. White DR, Cotton RT, Bean JA et al (2005) Pediatric cricotracheal resection: surgical outcomes and risk factor analysis. Arch Otolaryngol Head Neck Surg 131:896–899

    Article  PubMed  Google Scholar 

  20. Rutter MJ, Hartley BE, Cotton RT (2001) Cricotracheal resection in children. Arch Otolaryngol Head Neck Surg 127:289–292

    Article  PubMed  CAS  Google Scholar 

  21. Sandu K, Monnier P (2008) Cricotracheal resection. Otolaryngol Clin N Am 41:981–998

    Article  Google Scholar 

  22. El-Fattah AMA, Ebada HA, Amer HE et al (2018) Partial cricotracheal resection for severe upper tracheal stenosis: potential impacts on the outcome. Auris Nasus Larynx 45:116–122

    Article  PubMed  Google Scholar 

  23. Monnier P (2018) Partial cricotracheal resection and extended cricotracheal resection for pediatric laryngotracheal stenosis. Thorac Surg Clin 28:177–187

    Article  PubMed  Google Scholar 

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Correspondence to Ivana Fiz.

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Fiz, I., Monnier, P., Koelmel, J.C. et al. Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study. Eur Arch Otorhinolaryngol 276, 785–792 (2019).

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